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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m -- I o <br /> APPLICATION FOR — LAND USE — PERMITS 0 <br /> m s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> re lations of the State"I nsin. Se � <br /> o. f <br /> OW ER Please Pri Contractor or Surveyor or Agent o <br /> Address rn • �� Address <br /> C Gmlik 5 <br /> City State, Zip Code City,State,Zip Code <br /> ?r/2- S9.Q - 3 Sal <br /> Telepho a Telephone <br /> r�r✓Y 7 7 <br /> Enterggenyy/Fir¢No. nd Road Name `� <br /> ilO¢SiF YGrT �tv-SS j"wj� - ,50iotfy o`)y -Atpe ,i74/ <br /> Legal Description (as Indicated on tax statement) <br /> c> <br /> Permits) Applied for: �. <br /> Dwelling Addition Filling/Grading Camping Unit ° o <br /> Z v <br /> 'o <br /> Accessory Building Sanitary Privy Subdivision ° m <br /> Garage <br /> a <br /> Structure Use. ( • / 9 ) A 4 Senofmakm <br /> OC UJ / � 0 W. �rV��Q' I� r <br /> oI <br /> (family home/cabin,garage, addition, +.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings(NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfieid (DF). 3 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. c <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C w 1 {fit <br /> dated by the owner. <br /> PLOT PLAN f � m I <br /> �C Ltd'! Cb�t,v „Lz�Zx �'� Ldii� <br /> CdrGi� (/ ,LC >'�CLI' Qr <br /> CA0 <br /> P�ernil , <br /> o I <br /> o <br /> w <br /> M o C WN r; .> >, ? m <br /> mz .2 Co Oro' 3 <br /> o o Z 1 <br /> Fm � T m M <br /> � Cr m <br /> ` i m c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor-mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 g m g <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap. <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O o <br /> access to the above deacri premises at any reasonable time for the purpose of inspection. m 89 <br /> m E 3 <br /> p . <br /> SIGN HERE / <br /> N: a <br /> (signature of owner r ifldln cont r 1Q�a <br /> WING ADMINISTRATOR `' (C \J [ <br /> TOWNS IP PERMITS MAY BE REOUIRED MAY 2 9 !^ I g s 8 y <br />